Private Practice – Episode 1
Episode Title: In Which We Meet Addison, a Nice Girl From Somewhere Else
Since I like a couple of the actors, I thought I’d give ABC’s new show Private Practice a try, even though it’s a spin off of Grey’s Anatomy (which I found too soap opera-y and mopey). Like it’s predecessor, Private Practice favors the dramatic over the medical, but so far has avoided the emo trap. The show seems to be trying a little hard to be both serious and quirky (Cooper, for instance, is more caricature than character), but it has potential.
I don’t plan on doing in-depth reviews like I do for House, but here are the medical issues that caught my eye in this episode, arranged by doctor.
Dr. Addison Montgomery/ Dr. Pete Finch
As anyone who’s joined (or started) a practice can attest, there is an incredible amount of paperwork involved — state forms (license, controlled substance registration) and reams of insurance forms, just to name a few. Unless Naomi was handling all this paperwork herself, someone else in the clinic would have known Addison was joining (Now if Addison already had a California license and the clinic doesn’t take insurance or carry malpractice, then there wouldn’t be nearly as much paperwork).
JVD (Jugular Venous Distention) is a very sensitive sign of congestive heart failure, which this patient seems to have suddenly developed. I get the feeling the writers were shooting for peripartum cardiomyopathy, a rare but serious form of heart disease associated with pregnancy. The sudden onset of her symptoms is unusual for this condition, and would make me concerned about a heart attack or amniotic fluid embolism leading to congestive heart failure. Other causes would include mitral stenosis and aortic stenosis.
They put the patient on oxygen, but it would have been nice for them to give her other medications to relieve her symptoms (diuretic, for instance).
Supposedly the baby was in trouble, but the heart rate (140-150 with normal variability) looked good to me.
If I were undergoing major surgery (and c-sections are major surgery), I would want more than acupuncture for anesthesia, even if it was electrified acupuncture.
About twelve years ago, there was a popular computer game that simulated surgery and allowed you to pretend to be a surgeon. There were only a few surgeries you could perform (appendix, AAA), and you quickly realized that the game had every single patient go into v-fib during surgery. Watching shows like House and Private Practice, I feel like I’m playing this game again when every patient goes into cardiac arrest. Real life isn’t like that. Anyway, it was nice to see they had a crash cart, and their treatment of the code – what little we saw – looked OK, but I wonder about putting her on a Lidocaine drip when we didn’t see them give Lidocaine during the code itself (but again, we only saw part of it).
Dr. Naomi Bennet /Dr. Sam Bennett
For patients who are uncomfortable with providing a specimen in a cup, there are specially made condoms that allow both partners to participate in the collection. The results are better if you do it yourself, but some is better than none.
Why did they provide CPR for 20 minutes without breaking out the crash cart? We know they have one in the clinic – this would have been a good time to use it. And if you’re going to defibrillate the patient, it’s be nice to know the heart rhythm first.
Post-mortem sperm has been collected as long as two or three days after death. It’s still an uncommon procedure — and mostly unsuccessful too, with only 1 successful use in the U.S.. As this episode showed, the ethics are still unclear.
Dr. Violet Turner/Dr. Cooper Freedman
They never explicitly stated the diagnosis, but this patient clearly has obsessive compulsive disorder (OCD). In short, OCD is a type of anxiety disorder – the patient was counting tiles to drive the stressful thoughts of her dead son out of her head. I can see how she would quickly relapse into OCD when she saw the kid in the video, but I can’t see her being talked out of it that easily.
September 27th, 2007 at 9:04 pm
I remember that game! Life & Death. I was never very good at it.
September 27th, 2007 at 10:13 pm
I actually had some questions about tonights CSI ep as well. I’ll try not to give away any spoilers, but at least basic info is mentioned next, so you are warned:
At one point there is someone with heatstroke who is several times described to not have a pulse (or, at least, no one can feel a pulse). Up to and even after when professional medical personnel arrive, no CPR is given, and eventually an oxygen mask is placed over their face with no intubation performed. Maybe I’m missing something, but wouldn’t someone with no pulse not, you know, be breathing? What’s the point of a mere mask at that point? One of the med techs does later say that they “still can’t feel a radial pulse” which could maybe imply that they COULD get a pulse elsewhere, or otherwise knew that the heart could still be beating faintly along with actual breathing. But it still seemed like some pretty questionable medical care. “The unconscious patient is not responding to verbal requests to open their eyes and talk to us: WE’VE TRIED NOTHING AND WE’RE FRESH OUT OF IDEAS!”
Also (and this is a little more of a spoiler):
wouldn’t an educated person know that when you are lost in a desert, it’s best to stay in a single location (hopefully also one that’s better shaded) near an important and identifiable landmark that your rescuers are sure to look for and find first, if they find anything… rather than walking off randomly into the desert?
September 28th, 2007 at 1:12 am
Official Comment
John,
Thanks! That was the name of the game, alright.
Bad,
I just watched that episode. I was thinking: “If she doesn’t have a pulse, then why aren’t you performing CPR?” It could be that she’s so dehydrated, it’s hard to find a pulse, but it’s there (and if that’s the case, good luck getting the IV in).
I was also thinking she should have stayed atop the pile of rocks to see and be seen. I know the area she was stranded in pretty well, and if she was just outside Icebox Canyon, there’s a nice stream there she should have been able to hear that recently after a rainstorm. It’s also about 10-15 degrees cooler in that canyon (hence the name). She should have just headed that way.
September 28th, 2007 at 7:44 am
I still can’t figure out why they didn’t call this show “Addison’s Disease”…
October 4th, 2007 at 7:14 pm
“I still can’t figure out why they didn’t call this show “Addison’s Disease”… ”
AHAHAHAA! XDDD I hate this show too. -_-;
October 8th, 2007 at 2:28 pm
Hi!
I keep forgetting your blog (sorry!) but someone at alan sepinwall’s mentioned it in a House thread so here I am and I find Private Practice!
I’m a Grey’s girl myself (yes, I’m very fond of sappy, although I did like season one, where they were *actually* residents (okay interns) and actually did some work, more. but I didn’t fall for the show till sappy season 2, so…). My brother likes PP though, and I can endure it, no problem. Even if I’m not fond of most of the characters (I can relate to Violet the most – wouldn’t you expect)
Thanks for decoding JVD, since they didn’t (why did I think it was a sign of cardiac tampanode or pericardial effusion or something?)
and
Do you ever watch the almost medical shows? I’ve been doing Diagnosis X on TLC. More fun than Mystery Diagnosis (for one thing, no never-ending closeups of people’s *eyes) and they toss in some recurring actors with a tiny non-medical subplot, that, somehow, the real doctors manage to play along with.
Also, 5 eps in, I finally noticed they were using the hospital from Scrubs.
Pardon me for asking rather than just perusing the site. I’m between piles of work (though they should be light considering our biggest client is having the holiday today. around here, you never know – I could get bombed with repairs)
-Pam, medical (fiction) show junkie – I’ve seen everything set in a hospital except for Ben Casey, since I started with reruns of Dr Kildare when I was in my single digits. But I don’t do dead people (CSI,Bones, etc.) It all started with those Cherry Ames novels I read as a kid….
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